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Although plastic surgery has been around for centuries, its techniques and safety measures have evolved over time, as with its trends. Jocelyn Stiebel investigates what procedures are taking the limelight away from the long-worshipped size-D breasts.

Today, society’s beauty norms are constantly challenged, allowing them the space to change and become more inclusive. And with beauty norms changing, so do beauty trends. Enter the cleavage. Or rather, for the sake of the topic, exit the cleavage, which has over the years become less popular, with women preferring smaller breast sizes and opting for breast reductions, or smaller, natural-sized implants instead. Pamela Anderson and Carmen Electra are two of the many celebrities who made huge boobs the thing to aspire to in the ’90s and 2000s. In fact, breast augmentation in larger sizes saw its peak in the early 2000s. ‘The size of the boobs that patients want nowadays has decreased, and the shape dramatically changed. Previously, patients opted for rounder boobs, like that of Victoria Beckham. Now women prefer a softer curve, with less volume,’ says Dr Nerina Wilkinson, plastic surgeon at Renaissance Body Science Institute in Cape Town, who has been practising plastic surgery in South Africa for 20 years.

While the ’90s may be dominating current fashion trends (think cropped tops, platform shoes and flared trousers), positively round, protruding implants favoured in that decade seem to be few and far between. And this is all in spite of the fact that cosmetic surgery continues to grow in popularity, with people being more open to undergoing surgery.

Dr Vivien Jandera, plastic surgeon at Hazeldean Medical Centre in Silver Lakes, Pretoria, believes that ‘aesthetic plastic surgery is more accepted in society today than it used to be. People are more open with their family and friends about it. The readily available information on the Internet and social media helps with this.’ It must be noted that breast-augmentation has not decreased in popularity – it’s still one of the most sought-after cosmetic procedures worldwide. In 2015 there were 291 200 breast augmentations performed in the US, and only 67 080 breast reductions; in Brazil in the same year, 159 225 breast augmentation procedures were performed, with 72 600 reductions. Dr Vivien sums it up nicely for us in ratios. ‘Roughly speaking, the ratio of breast augmentation to reduction in the US is 3:1, whereas in South Africa it is 1.8:1.’ Although South Africa tends to follow cosmetic-surgery trends from abroad, we have a more diverse population, with a wider spectrum of motives for cosmetic surgery to that of, say, the US. ‘There are many reasons why breast-reduction surgery is more common in South Africa than augmentation, but one of them could be because some medical-aid plans now cover the procedure, seen as functional more than cosmetic. And rightly so,’ says Dr Marisse Venter, plastic surgeon at Netcare Milpark Hospital in Johannesburg. ‘Rightly so’ because breast reduction is more of a necessity than choice for many women.

Dr Gloria Tshukudu, South Africa’s first black female plastic surgeon who practices breast-reduction surgery mostly on people of colour, can attest to this. She receives up to five emails a day from patients requesting information on breast-reduction surgery for numerous reasons that include shoulder pain, excessive sweating and irritation of the skin under the breasts, and poorly fitting bras and clothes. Aside from functionality, women want smaller breasts (either by reduction, or choosing smaller implants) for aesthetic reasons too. ‘Over the years we have seen more patients requesting modest augmentations, driven by the current “fit is the new thin” trend,’ Dr Marisse says.

Certainly, over the years there has been increased awareness of what it means to be healthy, natural and fit. In the ’90s, the supermodel body was the epitome of idealisation for many women around the globe, but for the most part highly unattainable. If you weren’t six-feet tall, blonde and naturally slender with legs for days, there wasn’t much you could do to change this. But nowadays, natural is seen to be beautiful – regardless of height and body type. If you eat consciously, go to the gym or keep active, and look after your body, soul and mind you are considered to be healthy and natural – suddenly a much more inclusive environment than 15 to 20 years ago.

In other words, the aesthetic goals have changed from balloon-shaped boobs achieving maximum cleavage to more natural-looking, moving away from the ‘bigger is better’ reference that was long glorified. ‘But requests are individualised,’ says Dr Marisse. ‘Some patients of mine request the “Dolly Parton look”, while others the “Kate Hudson look”.’ On the couch in Dr Nerina’s office where we meet, she has laid out a few samples of different breast implants. ‘These here,’ she points to the obviously round-shaped implants, ‘are the breast implants of the ’90s. For a time, these were the only shape available.’

Luckily the implants manufactured in the last eight years are more advanced, giving women options of breasts that will better fit both their bodies and lifestyles. ‘South Africa tends to follow Europe’s medical developments, and anatomical breast implants are the most commonly used model in Europe,’ says Dr Nerina. She informs me that 80% of breast implants used are anatomical, while just 20% are the round shape. Anatomical implants mimic the shape and contour of the natural breast. ‘Breasts are pear-shaped, naturally,’ says Dr Nerina, ‘with the bulk of the breast tissue sitting at the lower half of the breast, almost like a teardrop.’ Anatomical implant gel differs to that of round-shape implants; its ergonomic gel allows the implant to rotate and move naturally with the body because of its elasticity. So if a woman lies down on her back, the implant will respond to gravity and move the same way that a natural breast would.

The year 2014 was dubbed the ‘Year of the Butt’ thanks to Kim Kardashian and her famous derrière stealing the breast’s limelight. Around that time, bigger and shapelier bums became more desirable than the previously worshipped big bosom. Even Dame Helen Mirren, a famous advocate for body positivity, noticed the shift, stating publicly ‘it’s wonderful that you’re allowed to have a butt nowadays.’ Kim’s butt was everywhere, and women who were blessed with junk in the trunk were suddenly worshipped for that very reason. This undoubtedly resulted in the rise in buttock-enhancing injections, which was the fastest-growing cosmetic surgery in the US in 2015. I asked Dr Nerina if South Africa experienced the same phenomenon. ‘In South Africa big butts represent wealth, fertility and good health in some cultures,’ she says. But she saw a 20% increase in the number of white women requesting butt-enhancing injections – women who wanted to fill out their jeans and create an hourglass look.

Liposuction still remains one of the most popular cosmetic-surgery procedures, with many opting to have the fat that was removed injected into their faces to add volume to the skin, smoothing out wrinkles and plumping up the lips. However, Dr Nerina warns that this will result in both the face and lips being severely swollen for up to three weeks. Whereas nano fat injections – which break down the stem cell-rich fat with a device into a cream-like substance, improving overall quality of the skin, stimulating new blood cells, collagen production and cell rejuvenation – give the advantage of fat injections without the swelling.

Probably the most recent of the many possibilities for desiring smaller boobs is the no-bra trend. It must be noted that going braless is as old as women’s liberation – the ’60s was famous for political protests and drugs, sure, but also for burning bras, quite literally. The #freethenipple movement was a campaign that started in 2012, and which advocates for women to, well, free the nipple – a metaphor, if you will, for women’s empowerment and liberation. As such, #freethenipple is supported by famous faces celebrated the world over, including the likes of Kendall Jenner who embraces the meaning of the hashtag, often pictured without a bra and with her nipples showing.

In a published conversation about the braless trend between five experts on Instyle.com, one is quoted as saying: ‘Anyone bigger than a size B is going to look saggy.’ Hence, perhaps, the desire for smaller boobs.

‘Women who undergo a reduction generally want to be much smaller than they naturally are, and go as small as possible for their frame,’ says Dr Nerina, who practised in Joburg before moving to Cape Town, and says there is a major difference between the two cities. ‘What are considered to be big implants here [Cape Town] are small in Joburg,’ she says. ‘On average, the most popular-size implant of choice in Cape Town is 220 to 225ml, which roughly translates to a full B-cup,’ whereas in Joburg and Pretoria the most popular choice for women is a full C-cup. Remember the old days when the absolute must-have lingerie item for your wardrobe was the Wonderbra? The more cleavage bulging from your spaghetti-strapped JT-One top the better. But new lingerie trends include the bralette – a teeny-tiny, (usually) lacy bra with no underwire or padding, which big-breasted women battle to wear for the lack of support. Even Victoria’s Secret, renowned for their push-up bras, has introduced the bralette to their catalogue after experiencing a rapid decline in push-up bra sales, resulting in a share-price drop of 29% in 2016, according to Refinery29.com.

Perhaps the most important thing to note about this change in trend (for lack of a better word) is that it is a lot more inclusive of diversity and choice than ever before. Whether you are big-breasted and embracing it (as you should), or on the smaller side and are thinking of getting implants to enhance your look – that is entirely your decision to make.